Excessive facial and/or body hair, scalp hair loss and increased acne due to high levels of androgens can be distressing. There is a range of options to assist you:
Creams or gels which reduce pore blocking, oil production by the skin and inflammation can be used to treat acne.
Waxing, laser hair removal and electrolysis can be useful measures for reducing hair growth. Of these, laser is the treatment most likely to result in a significant reduction in excess hair growth, but repeated treatments are needed over time, and treatment can be costly. If considering laser hair removal it is important to have this performed by a trained professional who uses the correct machine or technique for your skin type. Some dermatologist practices offer laser hair removal and have particular expertise in treating women with PCOS. They will be able to tell you whether laser hair removal will work on your skin type.
Scalp hair loss, excess hair and acne can be can be treated by:
- Reducing the amount of androgens circulating in the body using:
- Hormonal contraception
- Lifestyle changes leading to weight loss which helps to reduce insulin resistance
- Medications to reduce insulin resistance
- Reducing the action of the androgens on the body tissues using anti-androgen drugs such as cyproterone acetate, spironolactone, finasteride – these drugs are only used in more severe cases (see below for more detail on each of these)
How hormonal contraception works on hair & acne
Hormonal contraception in the form of the oral contraceptive pill ('the pill') reduces ovarian production of testosterone and other androgens, in addition to increasing the body's production of sex hormone binding globulin (SHBG). SHBG is a protein which binds tightly to testosterone in the blood, and is often present in very low levels in PCOS. Testosterone that circulates freely and is not bound to SHBG or other proteins is thought to be the hormone responsible for excess hair growth and acne. By increasing SHBG production the pill reduces the activity of testosterone and reduces the symptoms of androgen excess including excess hair growth and acne.
Insulin resistance & insulin sensitising drugs
Insulin resistance occurs where the body produces insulin, often in increased amounts, but doesn't use it properly. One of the roles of insulin is to keep the blood glucose levels from increasing by letting the glucose into the body's cells. If you are insulin resistant, your body doesn't utilise the available insulin effectively. For some women with PCOS, this will cause glucose to increase in the bloodstream along with high levels of insulin.
High levels of insulin can increase the production of androgens such as testosterone, in the ovaries. This contributes to excessive hair growth and acne.
A number of insulin sensitising drugs can be used to help with symptoms of excess hair growth and acne.
Insulin-sensitising drugs such as metformin have similar effects on reducing hair growth as the oral contraceptive pill. Metformin has been in use for around 60 years and is a drug with few serious side effects, except for in the elderly or those with liver or kidney failure. Some women who take metformin have some temporary gastrointestinal side effects (nausea, abdominal bloating, vomiting and loss of appetite). Metformin treatment can be started at lower doses to reduce the severity of these side effects. The slow release form of metformin, taken at night, has less severe side effects than standard metformin treatment.
Anti-androgens are available for use in more severe cases of excess hair and acne.
|Anti-androgen||How it is used||Side effects|
Cyproterone acetate (sold as Androcur)
|Must only be used with the hormonal contraceptive pill 10 days of each cycle||
|Spironolactone (sold as Aldactone) is a diuretic (fluid reducing) tablet that also reduces androgen production and blocks androgen activity in the body||
|Finasteride (sold as Proscar or Propecia) reduces the binding of androgens to the target tissues||
A treatment for acne, hirsutism and alopecia, but is not commonly prescribed in Australia
Isotretinoin (sold as Roaccutane)
Isotretinoin can only be prescribed in Australia by a dermatologist (skin specialist) for severe acne. This works by shrinking the sebaceous glands (glands that secrete substances onto the skin surface) and by reducing sebum production (sebum is made from cholesterol and fats and is one component of the oil on the skin's surface). This should be used only in women who are not trying to conceive and effective contraception such as the oral contraceptive pill must be used when taking this treatment, as there is a possibility of foetal abnormalities (birth defects). Side effects include dry skin and eczema.
Minoxidil (sold as Rogaine, Regaine, Avacor)
Minoxidil is a liquid or foam that is massaged into the scalp and helps to prevent hair loss. Side effects include scalp dryness and itchiness. Some dermatologists prescribe minoxidil in tablet form, often together with spironolactone.
Actions you can take
To make a decision on the best therapy to help with problems with hair and acne discuss your options with your doctor and seek the best quality health care you can. Prioritise what is most important to you and communicate this with your doctor.
McCartney CR, Marshall JC. Polycystic Ovary Syndrome. N Engl J Med 2016;375:54-64
Goodman NF, Cobin RH et al, American Association of Clinical Endocrinologists, American College of Endocrinology, and Androgen Excess and PCOS Society Disease State Clinical Review: Guide to the Best Practises in the Evaluation and Treatment of Polycystic Ovary Syndrome – Part 1. Endocr Pract. 2015; 21 (11):1291-300
Last updated 24 April 2018 — Last reviewed 20 April 2017
** Currently under review **
This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at April 2017.